PURPOSE: Malignant pleural effusions (MPEs) are common, although their management varies widely among pulmonologists. Providing ambulatory care to minimize hospitalization is a key goal for these patients. Indwelling pleural catheters (IPCs) are a new treatment for MPEs that allow outpatient fluid drainage. We hypothesized that MPE patients with IPCs require fewer hospital admissions.
METHODS: A prospective, multicenter, non-randomized study involving all three major respiratory centers in Western Australia. Patients diagnosed to have MPEs were followed up. In the absence of universally accepted guidelines on the use of IPC’ s, the treatment choice(eg IPC, pleurodesis, repeated aspiration) was decided by clinicians in-charge. Health care utilization, especially hospital admissions, was recorded. For patients treated with IPCs, i) bacterial cultures of pleural fluid were performed at least monthly; ii) serum protein and albumin (surrogates of nutritional status) were measured regularly; and iii) all other complications were recorded.
RESULTS: In 54 patients with a mean follow-up period of 73 days, 21 were managed with IPCs and 33 by other methods (10 talc pleurodesis and 23 repeated thoracentesis). Total hospital admission days (of all causes) were significantly lower in IPC-treated patients (median, 25-75th percentiles) at 4.0 (2.5-17.0) days over those who received other treatments at 10.0 days (5.5-18.5), p=0.045 by Mann-Whitney ranked sum test. Admission days for MPE-related causes were also significantly lower in the IPC group: 2.0 (1.0-6.0) vs 10.0 (4.0-15.5) days, p<0.001.Four IPC-treated patients had coagulase-negative Staphylococci cultured in the pleural fluid; none had clinical suggestion of empyema or required antibiotics. Patients in the IPC group had comparable reduction in protein (IPC group: 3.3 g/l vs non-IPC group: 1.6 g/l) and albumin at 3 months or time of death (whichever earlier), p= 0.616 (protein) and p=0.59 (albumin).
CONCLUSION: Management with IPC significantly minimizes hospital admissions in MPE patients and was safe.
CLINICAL IMPLICATIONS: Management of MPE with IPCs allows patients to spend more of their remaining days outside hospital, which also reduces consumption of hospital resources.
DISCLOSURE: Edward Fysh, University grant monies Edward Fysh is receiving a PhD scholarship through the University of Western Australia.; Grant monies (from sources other than industry) This study is funded by a project grant of the State Health Research Advisory Council of the Western Australia Department of Health; Grant monies (from industry related sources) None; Shareholder No; Employee Dr’ s Fysh, Musk, Millward and Lee and nurses McCarney and Morey are employees of the Sir Charles Gairdner Teaching Hospital, Perth, Western Australia. Dr’ s Kendall and Bremner and Nurse Dina are employees of Fremantle Hospital, and Dr’ s Waterer and Leong are employees of Royal Perth Hospital.; Fiduciary position (of any organization, association, society, etc, other than ACCP No; Consultant fee, speaker bureau, advisory committee, etc. No; Other Dr Lee is co-investigator of the British Lung Foundation TIME-trial. Rocket (UK) provided the indwelling catheters for that study without charge. None of the investigators receive any personal benefits from the study.; No Product/Research Disclosure Information